Is Aetna the only one?

[MyBodyFreedom 9]

I went for my consultation last week. Although my doctors thinks I will have better resolution with the gastric bypass I'm still opting for the sleeve. When I sat down with finance I found out Aetna has a crap load of hoops and hurdles that have to be done before they will even allow the request to be submitted for approval. Are all insurance companies like this or just Aetna?

[AuriP 420]

I believe all insurance companies are like this. When I got the lap band I had to have a ton of things done.

-2 nutritionist appointments

-2 surgeons appointments

-Psych evaluation

-Chest X-ray

-Lab draws

-Upper GI

I forget if there was more but that was most of it. They really want to make sure you are serious about this. I have Preferred One out of MN.

[BeccasFreeLife 7]

I have Aetna too and like AuriP said, most everyone I've talked to on other plans have to go through the same guidelines. The only ones who do not have to jump through hoops are self pays.

When I decided to even begin looking into VSG my weight was 217 and my BMI was 41.9. But I had started a Diabetic diet with my husband and had gone down to 206 which put me under a BMI of 40. So my only option was to be tested for sleep Apnea as a pre existing condition.. Thankfully (Or not, depending on how you look at it) I do have moderate to severe sleep Apnea so that qualified me.

Don't give up! Keep doing whatever you have to do. Aetna pays 80% of the cost. I'm lucky in that we had already met all deductibles this year so I am covered at 100%!!

[gastricsleever 259]

I went for my consultation last week. Although my doctors thinks I will have better resolution with the gastric bypass I'm still opting for the sleeve. When I sat down with finance I found out Aetna has a crap load of hoops and hurdles that have to be done before they will even allow the request to be submitted for approval. Are all insurance companies like this or just Aetna?

All insurance companies are like that, if they even cover the surgery. You're lucky your insurance covers that, my insurance covers nothing even if I were to jump through hoops there are no hoops for me to jump through… They just don't cover the surgery.

[MyBodyFreedom 9]

Don't give up! Keep doing whatever you have to do. Aetna pays 80% of the cost. I'm lucky in that we had already met all deductibles this year so I am covered at 100%!!

That is the part I'm frustrated with I have met my deductible and max out of pocket for the year so everything would have been covered at 100% but my Aetna plans requires a 3 month medically supervised diet plan (totally out of pocket) be done first. The many months I've been going to WW doesn't count. So there is no way I can get it done until next year when everything starts over again. As unfortunate as it is, it means my finances will dictate when I can actually have my surgery.

[MyBodyFreedom 9]

All insurance companies are like that, if they even cover the surgery. You're lucky your insurance covers that, my insurance covers nothing even if I were to jump through hoops there are no hoops for me to jump through… They just don't cover the surgery.

. When my husband had United they didn't cover WLS either. That makes no sense to me especially if it means helping the person have less needs for medication and medical attention.

[gastricsleever 259]

. When my husband had United they didn't cover WLS either. That makes no sense to me especially if it means helping the person have less needs for medication and medical attention.

I have united as well... Lousy lousy insurance!

[BeccasFreeLife 7]

Really??? Wow, now you have me scared! But so far everything has been going good. (Knock on wood) I haven't had to pay 1 cent for anything. Lord give me strength if they don't approve me before January, because like you, I won't be able to get it done for quite a while.

[MyBodyFreedom 9]

I have united as well... Lousy lousy insurance!

I hope they come around soon. It really would benefit them in the long run.

Really??? Wow, now you have me scared! But so far everything has been going good. (Knock on wood) I haven't had to pay 1 cent for anything. Lord give me strength if they don't approve me before January, because like you, I won't be able to get it done for quite a while.

Good luck! I hope it works out for you. Hopefully they can do it just before the new year so that won't happen to you.

[De-jo 22]

All insurance companies are like that, if they even cover the surgery. You're lucky your insurance covers that, my insurance covers nothing even if I were to jump through hoops there are no hoops for me to jump through… They just don't cover the surgery.

Not all insurances are like that. I have Humana and I just had to have a specific BMI. I had some testing but it was things my dr ordered not required by my ins.

[BellaHugz 331]

I have Anthem BCBS and yes, the hoops the made me jump through are crazy. I am get a lapband to sleeve revision. Now all of that is done and Aetna they wanted a food journal as well for the last 4 years to see why the lapband failed. Hello, it was faulty. So, honey I hear ya on the co-pay's one of my test cost over 750- to make sure i wouldnt have gerd or acid reflux. And yes, I am close to meeting my 2000/yr deductible. So i now am waiting for an appeal service to help get approved Hoping and Praying for a miracle to get approved and have surgery before the year is up.

With all that being said, dont be discouraged hang in there. This is your life and you deserve to live it to the fullest.

Edited November 6, 2013 by BellaHugz